10.08.2010

Jolly and I are working this warm desert night when we get called for a car accident about 30 km south of our location. I let Jolly take the front seat and I hop in the back of the ambulance. From the dispatch information we receive en route we figure it's a single-car accident with two victims. Injuries unknown. I know this stretch of desert road pretty well. It's straight as an arrow and completely unlit. I drive it from time to time to work at a remote clinic about 140 km away. On the way to the scene, I find myself wondering what would cause someone to go off the road on such a straight length of highway. Well, I decide, I'll just have to see when I get there.

It's moonless and dark when we arrive. No streetlights and no other light source for a few kilometers in each direction. This is the middle of the desert, you know. We park as close as we can but the car is up a 2 meter embankment, about 20 meters off the roadway. Jolly goes ahead to check it out. Anticipating trauma, I grab two backboards, collars, and the usual. Jolly hollers at me to not bother.

This is going to be good. I scramble up the rocky embankment and join Jolly at the scene. Jolly is a local so he's doing all the talking with the local police and security personnel who have arrived before us. This frees me to check out the car. We have a Toyota Camry resting upright on its chassis. The front and the rear are completely smashed, there's not an intact piece of glass in the whole car and the sheet metal of the roof looks like it was ripped off with a giant can opener. No sign of the roof anywhere nearby.

There are no tracks leading to the car either. Just an impact print about 8 meters behind it, then blank sand then another impact crater a few meters back. End over end roll. Up a 2-meter embankment. Wow.

The driver (I assume he was) is completely wrapped around the center console. Yes, completely, like 270 degrees of twist. His head is so badly deformed that it's clear we're not rescuing him. Even assuming we can cut him out of the car. The nearest rescue squad is at least 45 minutes away. The passenger is lying next to the car and I get that the responding police had pulled him out of the front seat. He, too, has a badly deformed cranial cavity (skull). Even though there's no brains leaking out, both of these guys have what we call "injuries incompatible with life." No, they weren't wearing seatbelts.

Jolly and I proceed to search the surrounding desert. We surmise that the car bounced end over end and, without a roof, we worry there may be someone lying out in the sand having been thrown from the car. We work our way back along the estimated path of the car. From the bits, pieces and imprints in the sand we figure this car was going pretty fast. About 100 meters back, we find the gouges in the shoulder that shows us where the car went off the road. To have traveled 100 meters, bouncing end over end, that car must have been going pretty dang fast when it left the road.

100 meters further down the road, we see another police car with its lights on. There's a dark mass on the road in front of it. As Jolly and I work our way down the roadway, the smell hits us. I've not smelled anything so nasty and vile in my life. It's the smell of an eviscerated camel. We find the roof of the car. Most of it is still in the camel. A quick look tells us the story: Our two friends were speeding down the road when, out of nowhere, there's a camel in their headlights. They hit the thing full speed. I estimate they were doing at least 200kmh. This is not unusual in this country and specifically in this part of the country.

The front of the car snaps off all four of the camel's legs and the camel's body hits the roofline of the car. It rips the metal off the roof and impacts with both occupants' heads, killing them instantly, I'm sure. Bounce, flip, the camel goes over the car leaving the Camry to swerve a bit, travel a few more meters, hit the shoulder and begin it's aforementioned end-over-end flip dance to finally rest another 150-200 meters further on. It's an impressive display of physics, biology and plain stupid.

Jolly and I are shaking our heads as we get back in the ambulance and head home, leaving all three bodies for the police to deal with.

7.31.2010

His name is Ali and, according to the ER doctor, he's a pretty lucky guy. I have to agree.

We got called to an accident down the road. About 20 minutes later, we arrive at a crest in the road, made notable in the moonless night by the collection of cars and police lights.

About 30 to 50 meters off the road away is a bashed up compact car resting in the rocky sand. Our patient is the driver and he's secured to a backboard in a Red Crescent Society ambulance.

Here's a wierd bit: since the patient is an employee of my parent company the Red Crescent Ambulance waited on scene for about 10 to 15 minutes for us to arrive and take the patient to our company hospital which happens to be a few kilometers from their base.

Oh well. That's how thing are done over here.

The Red Crescent ambulances around here are staffed and equipped at a very basic level. Some have the ability to start IVs, administer glucose checks and give nebulizer treatments but that's about as advanced as they get. The Red Crescent guys had secured my patient to a backboard but hadn't secured his head, applied a cervical collar, conducted any examination or even taken vitals. They pulled their stretcher out as we approached with ours and I had to wade through the typical crowd of well-meaning but dangerous bystanders grabbing, pulling and trying to "help."

The Red Crescent guys don't speak English and my Arabic is not much more advanced beyond "Yes, no, thanks, hello," and "Where do you have pain?" but I immediately see that they want to lift the patient off their backboard and onto ours. I use a little pantomime, make eye contact, smile and then grab each of their hands and out them where they should be for a proper logroll. They get it right away and we do it by the numbers. It's neat to see that common training show up even across such wide gaps in culture and geography.

In short order, we get Ali transferred to my backboard and cot. I quickly move him into the ambulance so the nurse and I have room to work without being crowded by the bystanders, onlookers, police and anyone else. The nurse I'm working with this night, a strong-willed, unflappable and solidly competent Jordanian woman, makes the call to take this patient to our company clinic in the nearby city instead of our tiny "camp" clinic. I think she realizes that there is an emergency physician on duty at the city clinic and only a general practitioner on call at our "camp" clinic.

I do my assessment en-route and find that he's got a painful left hip but no shortening or rotation of the leg. This would indicate a break in the thigh or dislocation or break in the hip where it meets the pelvis. His thighs are pain-free when I push on them and his pelvis is stable. All the rest of him is fine. No signs of head trauma, lungs are good and clear, extremities are intact and give good pulses and motor/sensory response. All his vitals are fine. The only thing is this hip pain and the fact that he doesn't remember a big chunk of the accident. I wrap a folded sheet around the upper part of his thighs and tighten it like a band. This produces immediate relief from his pain. Other than an IV and monitoring, that's about all I can do for the guy until we get to the hospital.

From what Ali tells us, he went off the road, not wearing a seatbelt, and rolled "many, many times." During all this rolling he said he "went out the window" and landed in the sand. So, we're looking at the unbelted driver of a car involved in a multiple rollover with ejection. All he's got is a painful hip and a few cuts on his hand and thigh.

7.20.2010

There are times when I look down and see my hands. Yes. Of course. We all see our own hands all the time, but there are times when I see them.

My fingers are pretty long. Sometimes I think they're too long to be "manly."

My fingernails grow too fast. I want short, unobtrusive nails that don't look shiny or pretty. However, they just grow that way (and fast!).

"Clip...clip...clip...,clipclipclip"

Herself tells me that my hands are big and strong and make her feel safe. When she's not there: I don't see that.

What I see is my hands being wrong for what I want them to be.

I want my hands to be strong, every time. I want my hands to do the perfect thing, every time. I want my hands to be absolutely and perfectly "right on" every moment they touch someone.

Every time I touch a patient, I question that. It doesn't matter how well I do my job. It doesn't matter how well (or poorly) my patient ends up. I will always look at my hands as if they belong to someone else.

7.10.2010

Well, that answer is complex, nuanced and full of opinion. I ain't ready to fight that battle in the blogsphere yet.

However:

All of us paramedics get the same training, to a point. We all have to pass the same (or similar) test to be blessed as a paramedic. There are folks who will argue the contrary but, please, for the sake of my posting, let's assume my statement is true. I'm sure I'll get a bajillion comments when I finally do post on what makes a "good 'medic" but today, I want to talk about one thing that makes this guy a "good medic."

Some of the best in our profession don't try to be doctors. We don't try to be nurses. We recognize that this is what we do and we put effort into doing it better and into improving the efforts of those who come after us. There's a lot to be said for being a paramedic. There's a bit more to be said for being a good paramedic. There are volumes to be told for being a great paramedic.

What is "that thing?" What is the one thing (if we can condense it down that much) that makes the difference between a paramedic and a "good" or, even, "great" paramedic?"

The short answer forme is, "I don't know."

But I do know what I've seen in the paramedics, EMTs, Firefighters, Cops and public servants that I've met in my job.

We care.

When we do our job, no matter how busy our county/system/service/company is, we treat one patient at a time.

When we have the privilege to treat them, they are the ONLY patient we've ever seen and ever will. It's the zen, hokagare, samurai way, or whatever you choose to call it, but it's what paramedics do. We are called upon to consistently deliver the compassion, care and individual feeling that makes that difference. Everyone who needs a paramedic becomes a member of our family. Some of us want to do well. Some of us are just tired of the dying and killing and some of us, honestly, want to really, REALLY, help.

When the public (yes, you!) see us. You are at your worst. That only challenges us, further, to be at our best.

Nobody is a 'medic for the money.

Nobody is a 'medic for the groupies.

We do it (and keep doing it) because we care.

This guy? I hope someone like him comes to my house when I have to make "the call."

7.08.2010

A combative patient is one that fights treatment or control. This can happen for a variety of reasons. When we talk about combative patients in EMS, typically, we're talking about folks who have a brain injury or are hypoxic (brain's starving for oxygen) and they start flailing about. You see, when the brain's in trouble, i.e. starved for oxygen, the body kind of goes into "freak out" mode and starts lashing around in an attempt to somehow correct its oxygen starved state. When you're the paramedic in a small box that's moving down the bumpy road at high speed with said combative patient, this is what is sarcastically referred to as, "fun."

Now, there are patients that are combative because of a physical injury. Then there are patients who are combative due to a chemical insult (too much booze, pills, or whatever they ingested, snorted or shot up) and then there are patients who are combative just because they're ornery! Yep. The injured a**hole. Now, technically, we shouldn't refer to these patients as "combative." That term is usually reserved for folks who do not possess the ability to make an informed mental decision and we've got to fight 'em for their own good. The very reasons they are in such a combative state also usually alters their mental faculties so that they can't give or withhold their permission for treatment. That's when we get "implied consent." and proceed to do the things necessary (we hope) to save their lives, etc..

Some folks are just a pain in the butt. They get themselves all banged up, cut up, sick or otherwise in a bad way. Not enough to alter their mental state, mind you, but enough so that someone calls for a paramedic and they actually need some treatment. But they get stubborn and it's a constant argument to get them to let us do the simplest things. For example, I had a patient a while back who had an unfortunate meeting with his lawnmower. This 80-year old gentleman got tired of waiting for, "them darn kids" to show up and cut his grass that he went out, sandals and all, to do it himself. Well, needless to say, the mower somehow rolled back and he's a bit stubbier on his left foot than his right as a result.

We arrive, find him bleeding a bit, uncomfortable, furious, ornery and in full possession of his mental faculties. No, he doesn't want us to take him to the hospital. No, he won't let us bandage his foot. No, we can't start an IV and hook up the monitor. Who cares how many cardiac medications he takes, "I ain't goin!" All the while he's swatting at my partner and I when we get close, waving his arms around and being a pain.

In the time It took his wife, daughter, my partner and I to convince him to let us treat and transport him, I could have driven him back and forth to the hospital 4 or 5 times. Yes, I could have taken a refusal from him but I would have been back later when he finally gorks out! This happens more often than I'd like in the USA.

Now I'm over here in the Kingdom and there are a lot of differences. I don't see as many drunk, high or chemically altered patients as I did in the USA. I know they exist in the Kingdom but not where I practice, I guess. I also expected a lot more distrust and even open hostility to my white face and lack of Arabic language skill from many of my patients. However, that's just not so.

The men who have fallen under my care seem to be in one of two states: Dramatic flailing, wailing and hollering over the tragedy and pain or completely limp as if they had swooned. Usually, if they're in the first state, they quickly swoon with a melodramatic sigh as soon as a medical person shows up. I'm always so surprised at how uncomplainingly they put up with any of my treatments. A patient may cry out at an IV stick, sure, but he usually doesn't pull back, strike out or otherwise act "ornery." It seems to me that, once medical help is perceived to be on scene, the patient just gives all into Allah's hands and sighs all the way to the hospital. After fighting ornery, bloody lawn-mowing 80-year olds, It's a nice change!

I haven't had any Arabic women patients. Usually, they are brought in by their husbands to the ER directly. I'm sure if I ever do have an encounter with a female patient over here, It'll be seriously blog-worthy!

6.23.2010

We get called for a motor vehicle accident (MVA) a few kilometers away on the nearby desert highway. Though we are a company EMS service that exists to provide medical care to our own facilities, we are often called upon to help out the general public. No problem. I like the work.

My Arab partner, AJ, and I both hop on the responding ambulance since it was reported there were multiple patients. AJ gets in the back and I ride up front. Neither of us is driving. Over here, the ambulance drivers are, typically, company workers from other departments who are nearing retirement. They have no medical training, limited usage of English and, other than getting the cot in and out of the unit, aren't very useful to a paramedic on-scene. We arrive at the place where two ribbons of asphalt meet in a "T" in the middle of the rocky waste of the desert. A small pickup truck carrying two young men went barreling into the intersection without considering the large lorry that had stopped to make the turn. That is typical of how men drive over here. Just go fast!! The rest is in God's hands!By the time we arrive, there are at least fifty men all standing around the accident scene, looking, talking to the victims, pulling them out of the car; It's chaos. The front of the pickup is trashed. The driver is sitting in the front seat looking dazed. There's a nice star on the windshield over the steering wheel. Ok, Got it.The passenger is lying on his back next to the truck. AJ and I can tell that he got out himself and laid down. He's pretty bloody from what looks like a busted nose but it's hard to tell what else. More on that in a bit. AJ and I have to physically push people out of the way to get to our patients. There's no concept of "stand back, the paramedics are here" in this country.The driver is swiveling his head back and forth and talking to people. I figure he's been there for about 20 minutes before we arrived, he can wait 5 more. (yes, It takes us that long to get there sometimes). I quickly decide to help AJ package the passenger.

Now. My USA readers must understand some key differences here: there is NO rescue squad, no fire engine blocking traffic, no reliable and competent rescue techs briskly deconstructing the wreckage to allow us easy access to the patient. Also, there is no concept of "get out of the way and let the paramedics do their job" either. Everyone who shows up either wants to get close and look or feels they can contribute by grabbing the nearest thing and pulling, pushing, hollering and getting in the way. I get more than a few angry looks as I use my 230 lbs to shove people out of the way between the patient and me.

Oh, police? Yes, the police are there. Probably the ENTIRE shift has come to the scene and parked their cars everywhere. Only about half of them have put their lights on. Are they controlling the crowd? No. They are a part of the crowd: equally shoving, pushing, jostling for a look and so on.

Like I said: Chaos.

Back to AJ and I with the passenger: AJ is chattering in Arabic with the patient. I do a rapid trauma assessment and find blood everywhere. Is the patient bleeding everywhere? No. He's wearing a Thawb. A Thawb (or Thobe) is a long, white garment that is traditional with Arab men. Imagine a white dress shirt that goes all the way to the ankles. They come in many colors but the most common is white and they're almost always made out of finely woven cotton. Which makes them an excellent blood sponge. I'm serious. Get a nick on your wrist and before you know it, your entire sleeve will be red and drippy.

This guy's got a bloody nose, a busted lip and a cut on his elbow. It's making him look like an extra from Shaun of the Dead. Talk about challenges to patient assessment! Awesome!

AJ and I quickly get this guy collared, boarded and loaded in the ambulance. Now, there's two patients and we're basically the only available ambulance for about 150km. We move the patient from the stretcher to the bench-seat and secure him with the seatbelts. He's maintaining his own airway, able to answer my questions and, since we have no other choice, is left in the ambulance while AJ and I go get the driver.

Yeah, I know. I'm sure some of you who are EMTs and paramedics are shaking your heads and thinking, "Abandoned your patient?" or "The driver should not have been left. He should have been boarded and collared too!"

Yeah, I know, I know, I know!!! I was thinking the same thing! I had just arrived from the USA and had not yet grown accustomed to being completely unsupported. Yeah, we had about 50 bystanders but they were all medically useless. Even if I had additional resources to call upon, even the most basic of them would have taken 30 -90 minutes to arrive. If a Mass Casualty Incident is one which the number of patients exceeds the capacity of the local EMS to handle, then this was an MCI.

And that's how we do it over here.

So, back to the driver: AJ and I again have to wade through the crowd to get to this guy. Collar on, lay him down onto the board. Slide board onto cot. Re-assess ABCs and we head for the ambulance. The crowd is getting so pushy and curious that we need some isolation to work. We get to the ambulance and I'm astounded to see it full!! There are about 5-7 Arabs in the ambulance. They're all talking to the passenger, kissing him, touching his head, one or two are weeping and one or two have a look of morbid curiosity on their faces.

Now, I've learned that my size and strange appearance (bald, beardless, big and, dare I say it?, burly) scares most of the Arab men I've met. I use this to my advantage. Out comes the "Sarge" voice and, even though I'm hollering in English, they get the message and clear out of the ambulance pretty quick as I go charging in.

We get the driver into the ambulance and divide our efforts. The passenger speaks a little English. He's mine. AJ discovers that the driver is asking the same questions over and over again and, though he denies losing consciousness, can't remember why he's there or how the heck he got into an ambulance. Both these guys are boarded, collared and can only look at the ceiling of our ambulance but they can hear each other. The driver is worried about the passenger. He keeps asking where he is and reaching out to touch him. The passenger keeps repeating that he's okay over and over again.

Yep! Driver's got him some head trauma!

Neither of these patients were in a hurry to die so, AJ and I didn't have too much of a challenge managing them medically. Our biggest challenge was physics. The driver of our ambulance (remember him?) has gotten so excited by all the drama, blood and people that he's driving the ambulance as if he were being chased by the devil. In all my years of having to deal with over-enthusiastic volunteer firefighter drivers, I've never encountered a ride as chaotic, bumpy, swervy and generally crazy as this!! Even in 35-foot (10 meter) seas in the Bering Sea, I had an easier time.

Keep in mind that, even though each of our patients presented with signs of pretty serious injuries, our treatment plan was constantly being adjusted and re-evaluated based upon priority, safety and the vagaries of the situation. If chaos is a sea, we do our best to surf the swells and keep from capsizing. Really!

Somehow, we managed to start a couple IVs, get some vitals, assess the patients, immobilize and bandage some injuries.

We survived the trip to the hospital which was chosen, not on the nature of the patient's injuries and the closeness of the facility but, as it works over here, by the employer of the patient. More on that later. In fact, my whole experience in a non-company hospital (we have our own) was so surreal and interesting that I think it deserves its own post with its own ruminations.

Suffice it to say that it was an eye-opening welcome to the world of EMS in the Kingdom.

My thoughts at the end of the call? "This is going to be a blast!"--maddog

5.07.2010

In the mean time: my laptop died, my home computer died and I got assigned to a remote area clinic even deeper in the desert.

At this Remote Area Clinic (RAC), I've had very limited computer access. The only computers available at work are the ones in the general emergency room and the attending doctor is is VERY nosy. I've stopped him a few times from reading over my shoulder. More on that later.

Well, now we finally have an office for the paramedics where I can blog in privacy. I have a few days off in about a week. Herself and I are discussing a drive to The Big City to get a replacement laptop. There's an Apple-authorized reseller and I need to see what the price difference is 'tween them and the USA.

Ok. I've actually had some calls and such. I'll be posting about that and paramedic life in the Middle East soon! I promise!

3.12.2010

I had made some raspberry ice cream with dark chocolate chips. I brought it in to work to share with my fellow medics and the ER staff. My Arab paramedic partner is amazed that I can cook and loves the soup and bread I've brought in to work. The ice cream prompts the following from him:

"How come you only have one wife? Chicks dig this kinda stuff, you know?"

3.10.2010

I use a software to track visitors to my blog. It gives me all kinds of useful information, including what search terms people entered that brought them to my site. Often they relate to EMS, sometimes people find me who were looking for another "maddog" and, every once in a while, I get a doozy.

We get a call for car vs. pedestrian right near the clinic. The caller reports that the victim is dead. Since it's quiet in the ER (no patients), the attending doctor decides to jump on board. The accident has occurred in a small area right outside the compound called "the Village." It's a collection of houses and shops that evolved from a squatters camp many years ago. Some of the houses are pretty nice now and there can be seen a few expensive cars parked here and there.

As nice as some of the houses are, the side streets are still mostly sand and gravel, there's no real street lighting and the one main road that goes through is not lit at all. Some time in the past, speed bumps were put in the road to keep folks from driving their customary 160 Kph through at all times of the day or night. All this means is that most of the drivers swerve off the asphalt onto the hard sand shoulder to go around them, often without slowing down.

This is obviously what our young driver was doing when he was probably quite surprised to find an old Bedouin in his headlights. It's clear he tried to swerve: there's only impact dents on the headlight and fender, but it wasn't enough. I have to literally shove my way through the crowd of men to get to the victim.

The Bedouin is lying in the sand about a meter from his leg. There's no active bleeding from the amputation site. In the lights from the ambulance, the sand around him looks black from his blood. I don't think there's a liter of blood left in his body. His eyes are glassy and fixed, blood and clear fluid (cerebrospinal fluid) are leaking out of both of his ears and his nose. This means that his skull is fractured inside and the fluid from his brain is leaking out of his head. No pulse, no breathing and his chest feels like a bag full of loose blocks from all the broken ribs. The nearest trauma center that might have a hope of helping this guy is at least 90 minutes away and he's busted up worse than a celebrity divorce.

The Doctor looks at me with her eyebrows raised as I check for a pulse. I shake my head.

"Get me a strip." She says casually. She means and EKG showing if there is any electrical cardiac activity. She's looked at the scene and put it together herself. She's not expecting any and neither am I.

I expose his chest to put on the leads and see that he must have tumbled or been dragged. His clothes are full of rocks and sand. In fact, I have to wipe away sand from his skin to get my electrodes to stick. Just as we expected, he's in asystole (Flat line, no heart activity).

Doc and I pack up and leave our bedouin to the care of his family and friends and the driver to the care of the police.

1.13.2010

2. Why I have been radically paranoid about posting anything for the past 2-3 years:

Well, it has to do with my fear of getting in trouble with my employer or with coworkers. You see, I've tried pretty hard to keep my blog anonymous. I've changed the name of the people involved, hidden some patient information and even edited a few photos to remove identifying marks and such. So far, as a simple medic in the big pool of medics out there, it's been pretty effective.

The privacy laws there are pretty strong. Also, my school is pretty unique and, I imagined, it would be very easy to figure out who I was and where I was teaching if I was blogging about my experiences there. Which is too bad. There were a TON of funny stories that came out of the classroom, let me tell you. So, you can imagine that I'm already unsure whether I should blog about my experiences at the Alma Mater. The job is time-consuming enough that I'm not getting out on an ambulance very much but I am teaching, guiding and, in some cases, precepting paramedic students who do. Lot's to write there, like I said.

Then one day, I'm walking down the hall from my office and one of my students walks by and says, "Hey there 'Maddog!'"

He doesn't use my name (Mr. So-and-so). He calls me Maddog. I don't go by that name on a regular basis and I require my students to always use title and last name when addressing anyone on the faculty and staff. Now I'm thinking, "Crap! One of my students is reading my blog!!!! ...and that means they probably are ALL reading it!!!"

This effectively shuts down any blogging I do about that job! It also tells me that I'm not nearly as clever as I think in regards to hiding my identity and such. Now I'm paranoid that everyone is reading what I've written and knows who I am and is furious with me! This paranoia extends to all areas where I'm working and has lingered with me for the past 2.5 years. Only now, with much to write about and the weight of this blog being 6 years old, am I working to overcome that and get more words out to you, my readers.

So, there you have it. I've had some sweet part time jobs in the interim, done some pretty neat calls at the volunteer house but, here again, I've been too paranoid to write about them. My intention when I started this blog was to keep the content focused around my experiences in EMS and related topics however, in the past two and a half years, I've been worried about violating privacy laws and offending people in my EMS world.

All of this leads me to the next item on my list:

3. A discussion about what I intend to do with this blog.

I still want this to be EMS related but, living in another country, there will be a bit more of the "personal crap about maddog" stuff in it. I've got a lot of content already from being here but not a lot of calls. I ran my first actual ambulance call just the other night and I've been here for almost two and a half months (yes, it's slow). Expect to see a comparisons of how EMS is delivered here vs the United States, a few stories about some cool calls and a bit of content about my travels outside work. I still need to work out how I'm going to write a lot of this and keep within the guidelines of my employer. You see, my employer is very clear about how quickly they will fire me if I break their rules of confidentiality and such. I like this job so far and I'm not keen on getting fired. We'll see how it works out.

I encourage my readers (if I have any left) to use the comments function and ask me questions. I'll write about what I think is interesting but let me know what you want to hear about. Thanks for reading!!

1.07.2010

"1. A synopsis of what the heck I've been up to for the past year or so"

In January, 2009, I had been working at the University for about 2 years and had all but made up my mind to leave. I was enjoying the academic life but I was realizing that it really wasn't for me. I didn't leave my job, sell my house and go back to school to be a college professor. I did all that to become a PARAMEDIC. Even though I was teaching students who, I hope, will become some of the best paramedics in the world, my personal practice of medicine was lacking. Working at the University was a sweet job, however. I was left to schedule and plan my own work. I had summers off, great benefits and all that stuff. It was sweet! However, I did have a lot more administrative crap that I wanted to handle and, when it came right down to it, I wasn't being a paramedic as much as I wanted to.

So I decided to leave.

I still had the rest of the Spring semester to finish working and, thank goodness, have an income, healthcare etc.. You see, Herself and I had a small business, a Yoga studio, that took a hard hit when the US economy dived. We had to close the business and still had a substantial chunk of debt hanging over us. We had burned through much of our savings and, with our income at the current levels, could pay back the debt over time but that didn't leave much for retirement and savings. Now, we could have defaulted, bankrupted, etc.. Many businesses fail and those who invested in or lent the businesses money end up losing too. However, we felt we needed to be true to our principles, we decided to pay back every dime. (No bailout for us!!)

So I needed to make a lot of money.

One option was to get two full-time paramedic jobs. It's possible with offset schedules and a lot of people do it. However, EMS agencies were feeling the economic pinch as well and many weren't hiring new 'medics. Things were looking grim on the home front. I was picking up a lot of part-time work in addition to my time at the university but not enough to sustain us once I left my teaching job.

So I started looking overseas.

With my military background and the current state of affairs in some parts of the world, there were a LOT of opportunities overseas for me. I applied to a plethora of jobs. I had offers to go to Khandahar, Baghdad, Darfur, and other such festive locales, mostly as a paramedic supporting contractor operations. As you can imagine, they offered me a LOT of money and, if I came home alive, I'd be pretty well off.

Meanwhile, in the USA, I'm working at an EMS company that does inter-facility transfers and provides staffing for an ALS chase car in a rural county. I'm having me some fun!!! I'll blog on that later.

Herself and I are preparing ourselves to be apart for a year or more while I go out into the world to seek our fortune. Kinda scary but the money's good. Then an offer pops up that looks really, really sweet! I end up taking a job with an oil company as a paramedic. This company is so big that they own their own hospital and several clinics as well as an EMS agency. They offer me a position in the middle of the desert in a very secure, stable and safe Middle-Eastern country.

Now, pardon me if I'm vague. My employer is pretty clear about releasing specific information about the organization and such. I'm still navigating how I'm going to blog about it and keep within the rules.

I'm offered less money than the high-risk war zone jobs but, Herself gets to join me, the company moves our entire household to a lovely house in a company-owned, company-built town in the middle of the rocky desert. The benefits are AWESOME and things look good.

So, after a summer of paper shuffling, interviews and medical checks, We've sold our house and moved overseas!!! We're now living in a lovely man-made oasis and, it being January at the time of this writing, the weather is LOVELY. (we'll discuss this again in August!).

So, there's the synopsis. Things are very good here. We have a lot of chances to travel. We've bought a 4X4 for desert camping and getting around. We call it the "camel" since it's brown, has a hump on the back (1999 Land Rover Discovery) and gets us across the desert. Work for me is VERY SLOW compared to what I was doing in the U.S.A.. However, the character of the work is very different. More on that later.... I promise!